Health Plan Enrollment Analyst

Integrated Resources Inc.; San Francisco (CA); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Referral bonus available

Job summary

Integrated Resources Inc. is seeking an experienced professional to oversee the credentialing of billing providers for healthcare services. This role is vital to ensure compliance with regulations and to support the revenue generation of the organization. Applicants should have extensive knowledge of federal and state laws, along with significant experience in healthcare settings.

Qualifications

• Minimum of 8-10 years of healthcare experience.
• Emphasis on provider enrollment and managed care.

Responsibilities

• Develop and oversee processes for credentialing billing providers.
• Work with Medicare and DHCS on regulatory changes.
• Resolve daily billing issues with agents and health plans.

Skills

Knowledge of Federal Regulations

Knowledge of State Regulations

Knowledge of Managed Care Regulations

Provider Enrollment Expertise

Education

Bachelor’s degree or equivalent

Graduate degree (substitutes for experience)

Job description

Integrated Resources, Inc. is a premier staffing firm recognized as one of the tri-state area's most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy, and Nursing.

Job Description

This position is responsible for developing and overseeing processes to ensure that all billing providers (approximately 2,000) at Client and its affiliates are appropriately and accurately credentialed and enrolled into all commercially contracted health plans, Medicare, Medi-Cal, and Tricare. This is essential to generate revenue, approximately $500 million annually, during patient care. The role ensures each billing provider is qualified to provide healthcare services according to Client policies and procedures, The Joint Commission, NCQA standards, commercial contracts, and applicable State and Federal laws, including the Affordable Care Act.

The position involves working directly with leadership at Medicare and DHCS to interpret changes in State and Federal regulations and assess their impact on Client, developing new processes as needed. It also requires working closely with Client billing agents and contracted health plans to resolve billing issues daily.

The incumbent should possess extensive knowledge of Federal, State, and Managed Care regulations.

Qualifications

• Bachelor’s degree or equivalent combination of education and experience; a graduate degree can substitute for experience.
• Minimum of 8-10 years of healthcare experience, with emphasis on provider enrollment, managed care, health plans at an academic medical center, or medical staff operations.

Additional Information

Feel free to forward this email to friends or colleagues who might be interested. We offer a referral bonus.

Thank you for your time and consideration. I look forward to hearing from you!

Thanks & Regards,

Integrated Resources, Inc.

(Direct) 732-844-8736

Gold Seal JCAHO Certified for Health Care Staffing

"INC 5000’s FASTEST GROWING, PRIVATELY HELD COMPANIES" (8th Year in a Row)